By Manny Ita
Nigeria has since her independence in 1960 had a very robust verbiage or policies by successive gobernments on health reforms but with very little progress or success recorded in what might well be a lack of political will in reforming the health sector.
Over 90% of the Nigerian population are without health insurance coverage. The inability to effectively address the country’s numerous public health challenges has contributed to the persistent and high level of poverty and weakness of the health system.
Political instability, corruption, limited institutional capacity and an unstable economy have also been major factors responsible for the poor development of health services in Nigeria. Households and individuals in Nigeria bear the burden of a dysfunctional and inequitable health system – delaying or not seeking health care and having to pay out of pocket for health care services that are not affordable.
The health challenges of the country include:
National Health Insurance Scheme (NHIS),
National Immunisation Coverage Scheme (NICS),
Midwives Service Scheme (MSS)
Nigerian Pay for Performance scheme
After many attempts at implementing legislation on health insurance since 1960, NHIS, although established in 1999, was eventually launched only in 2005 with the goals to ensure access to quality health care services, provide financial risk protection, reduce rising costs of health care services and ensure efficiency in health care through programmes such as the: Formal Sector Social Health Insurance Programme (FSSHIP), Mobile Health, Voluntary Contributors Social Health Insurance Programme (VCSHIP), Tertiary Institution Social Health Insurance Programme (TISHIP), Community Based Social Health Insurance Programme (CBSHIP), Public Primary Pupils Social Health Insurance Programme (PPPSHIP), and the provision of health care services for children under 5 years, prison inmates, disabled persons, retirees and the elderly.
The NHIS was expected to provide social and financial risk protection by reducing the cost of health care and providing equitable access to basic health services with the most vulnerable populations in Nigeria including children, pregnant women, people living with disabilities, elderly, displaced, unemployed, retirees and the sick.
Free health care services and exemption mechanisms are expected to provide financial risk protection for the most vulnerable populations but evidence suggest that they are ineffective and have failed to achieve this aim.
The maternal mortality ratio for Nigeria remain quite high at 814 per 100000 live births according to 2016 World Health Statistics. Across the country, pregnant women and children under five years are generally charged fees when accessing health care services, despite the federal government’s declaration of free health for pregnant women and children under five years in 2005.
The Minister of Health, Professor Isaac Adewole in 2016 announced the Federal Government’s plan to provide free health services to 100 million Nigerians in the next two years. Under this new health agenda, pregnant women across Nigeria are expected to enjoy free maternal and delivery services at the primary health care (PHC) level.
Unfortunately, Free health care services and exemption mechanisms often arise as campaign promises of political actors to the electorate and fall short in meeting the health needs of the most vulnerable populations. According to Nigeria Demographic Health Survey (NDHS) in 2013, over 60% of pregnant women aged 15-49 deliver their babies at home without any antenatal care visits. In rural areas, this value reaches 76.9%. The situation is critical in North East and North West regions of Nigeria where over 79% of pregnant women age 15-49 deliver their babies at home. Over 60% of pregnant women in Bayelsa, Plateau and Niger deliver at home rather than a health facility.
The cost of health care and the low quality of care by the public have been argued to be the reason for the poor utilisation of maternal and child health services in Nigeria.
In addition, health spending in Nigeria is low and this is responsible for the over-reliance on out of pocket payments for health care services.
Despite its launch in 2005, NHIS covers less than 10% of the Nigerian population leaving the most vulnerable populations at the mercy of health care services that are not affordable. This means the most vulnerable populations in Nigeria are not provided with social and financial risk protection. Poor people constitutes about 70% of the Nigerian population. They lack access to basic health services, which social and financial risk protection should provide, because they cannot afford it.
CBSHIP was expected to meet their health needs as well as provide social and financial risk protection to this group, which mostly reside in rural areas. As evidenced in the high rate of out of pocket payments for health care services , poor people financially contribute more to health care than official care and funds programmes in Nigeria. Out of pocket payments for health care services limit the poor from accessing and utilising basic health care services.
The quality of health care services delivered is poor and remains a huge source of concern. Most of the PHC facilities that are supposed to meet the health needs of the poor and rural dwellers are in a poor state due to poor budgetary allocation.
In trying to solve these issues, healthcare in the country must be tackled headlong in order to stem the detyeriorating development therein, which could portend grave danger for citizens of the country in the no-ditant future.
Policy makers and political actors need to devise health care reforms to address the lack of social and financial protection for the poor and vulnerable populations. Part of this reform is the expansion of the NHIS. States should be mandated to provide health insurance coverage to all residents. Making health insurance optional for states over the years has affected the ability of the NHIS to increase the level of coverage for the people.
While the mandatory CBHI scheme is being scaled-up as a supplementary measure, state governments should enrol poor residents in a private health insurance plan and bear the responsibility of paying the monthly premium per person to Health Maintenance Organisations (HMOs). It is not enough to have a national health insurance policy, it is important to ensure that health insurance coverage is provided to the poor and most vulnerable populations as a matter of the human right to health.
Although the NHIS Act made provision for children, who constitute the largest population in Nigeria, many children still have to pay for health care services in spite of being born into poor families that do not have the ability to pay for health care services and suffer financial hardship as a consequence. The free health policies and exemption mechanisms provided by some states, targeted at children, pregnant women and the elderly, are not social and financial risk protection policies, as these groups are largely responsible for the cost of health care with the free health care programme barely covering their basic health care services.
Another way of providing social and financial risk protection for poor and vulnerable populations is by establishing a legislative framework for a UHC scheme and setting aside funds for it. Evidence from Thailand has shown the effect of UHC schemes through PHC on expanding access to health care for the poor and vulnerable populations.
Political actors, policy makers and all stakeholders in the health sector should establish a government funded social and financial risk protection scheme through a general tax financing system for the poor and vulnerable, and invest in basic infrastructure for health care in rural areas for quality health care service delivery. UHC schemes are important in addressing the problem of poor coverage, limited access to health care, and poor quality of health care services.
Nigeria is yet to adopt innovative ways to protect the poor and vulnerable populations against financial risk of ill health. It is important to guarantee by law the right to health care of all citizens in Nigeria. Although the National Health Act (NHA) that was signed into law in 2014 stated that all Nigerians are entitled to basic minimum package of health care services, it is not clear if the provisions made in the NHA are capable of achieving UHC in Nigeria. In addition, the NHA is yet to be implemented over two years after its signage into law.
Some low- and middle-income countries (LMICs) have been able to provide social and financial risk protection schemes for poor and vulnerable populations as a matter of the human right to health. Therefore, there is a need to provide social health protection schemes targeted at these groups in Nigeria. The poor and vulnerable populations should not become impoverished because of failure to obtain much needed health care services. Governments must reduce out of pocket payments for health care services by households through the adoption of a tax financed non-contributory UHC scheme.
Interview: Princewill speaks on his health, Amaechi, APC, Buhari and Rivers politics
We recently heard you survived 5 mini heart attacks before you were properly diagnosed in a London hospital. What really happened?
Six in total if you count the one that happened in the hospital between when I did my ECG and while I was waiting for my chest X-ray results. The truth is I had been having many episodes of chest tightening and I could not explain it. First in Dubai, then in Nigeria. After one very bad experience, I went to a hospital in Abuja and was given medication for indigestion which surprisingly made me feel better. It was not until I got to London that it reoccurred and my wife insisted I should be taken to the hospital, that we found out what it was. Just the ECG and blood tests revealed there was a problem and so without delay I was rushed into the theater and operated on. If I had not come in, the damage would have spelt the end for me. A few quick lessons to be learned. 1. Listen to your wife. 2. Doctors without equipment is trial and error and 3. Many people die for lack of treatment. The whole experience was free. Not one Naira was spent. Because two days later was my wedding anniversary, they let me home the following day to go and enjoy my second lease on life. The final lesson is between your symptoms and an equipped doctor, there are things you can do. Mine was breathing exercises. A simple google search will reveal the different types. I used them to save my life. Now I’m up and about and feeling even better than the weeks leading up to when I went in. It’s God.
With all the stress of politics and your passion for progress, are you not tempted to slow down and take life easy?
I’m glad you used the word passion. That means you know it’s not a thing you turn on and off as you see fit. I have seen the world, I have seen Nigerian politics, I know what is needed and I know who can get it done. Why then would I look the other way and mind my business? Because I’m looking for food? No. Food will find me. I’m not that hungry. With this heart attack sef, I need less of it. I strongly believe in the potential of Nigeria and I truly believe in the genuineness of men like Buhari, Amaechi, El Rufai and others. I’ve seen the sincerity of some men in the legislature, the business community, the arts and at the grassroots level in Nigeria. We have enough men and women to build a better Nigeria for all of our children. I choose to help them. Especially when they make mistakes. Nobody is perfect.
Rivers state is in the news again for all the wrong reasons. Be it internal APC issues or statements from your Governor. Any comments?
We have a history of being very outspoken, especially on social media. Even secondary school children are posting political opinions on Facebook. During Odili it was not like that. But they were one family then. Now the family has broken up and they all think that they are equals. Besides there is a benefit for being an equal or a close ally of an equal and that benefit is what politicians from 1999 have lived on. Stopping it now is not easy. That’s one reason. The second reason is outside influences. Rivers state is the donation capital of Nigeria. It’s influential just by virtue of its place in Nigeria. They don’t call it the Treasure base for nothing. Even if Delta, Bayelsa and Akwa Ibom like they should take more allocation, Rivers is still Number 1 in the eyes of everyone. So being a friend of our Governor is a career path for many citizens both inside and outside the APC. I said it once and I’ll repeat it again. People in APC in Abuja conspired with Wike to prevent Amaechi’s candidate from becoming Governor in Rivers state. Why? Because if Amaechi has a Governor in Rivers state, he will be too influential in the Abuja equation for 2023. So unless Amaechi makes peace with his colleagues in Abuja, we cannot have peace in Rivers. In the meantime he is doing his work as Minister of Transport oblivious to them. I admire his focus, but I will be constantly preaching peace. Like I said in response to the Governor’s unfortunate comments, we don’t need to wash our dirty linen in public. While we spend huge cash on media, lawyers and frivolous costs, our people are looking for school fees, food to eat or money to invest in business. Who loses? I thank my father for giving me the wisdom to not respond.
Are you interested in contesting for Governor come 2023? Word from the grapevine says you are gearing up for it. Can you be open and tell us what you are planning?
I’m not going to be making the same mistake my brother and former Senator friend made by pushing for hundred before I even reach for one. The state of the party in the state is not conducive for any kind of electoral victory, talk less of a Governor. A total root and branch overhaul is needed to address the fresh management that we need. Unless you want to change parties as a protest. Not me. I have done that before. Doesn’t work. Becoming Governor in Rivers state is not a one man show. It requires a team effort and if you are talking APC Rivers state, Amaechi is the undisputed leader of that team. The grassroots believe in him and so without his support, you can’t win. 2023 is miles away, if we take care of the little things, other things will take care of themselves. I have shown that I’m not desperate to be the one on the chair. All I want is for Rivers state to move forward. It must not be me. But move forward it must. Amaechi is the leader in the state. If you don’t want his leadership, it’s not a cult, you can operate outside him. But let us avoid bringing each other down publicly for the sake of our party faithful, for the sake of our state and for the sake of our region. It’s not worth it. We can agree to disagree agreeably. Weakening APC strengthens PDP. I cannot support that.
What are your thoughts about the statement by Senate President that anything Buhari wants, he will get from the assembly?
In politics there are two types of people. The ones who care about the optics of how things look and those who just get on with it. I am increasingly leaning towards the latter. It’s important we put his comments into context. The Senate President is succeeding a predecessor who was a stumbling block to the executive at every turn. Without the benefit of his personal thoughts I think this Senate Preaident is distinguishing himself and the Senate he leads from that toga. Call him a rubber stamp or an extension of the executive if you like but he will not stand in the way of the much needed progress Mr. President wants to bring to this country. Thankfully he has given us a key deliverable already. A budget. In December, 2019. That is what my thoughts are processing.
Can a party with this level of crisis and amidst renewed calls for the national Chairmam to resign make progress and move the country forward?
Of course. It’s possible to chew gum and walk at the same time. Friction is a function of interaction. What is taking place is normal when you are viable. People fight over you. But our party is not running the government, the President is. Let’s leave internal party affairs to the party. They will resolve them, without the glare of you in the media.
The recent victory of APC in Bayelsa state fueled allegations of anti party activities against former President Jonathan. Do you wish to comment?
Not really. Except to say that the former President gave us Wike. I understand why. The enemy of your enemy is your friend. There is very little difference between the parties in Bayelsa. It’s not like they have a peculiar ideology.
When a Christian moves from one denomination to another, he or she still serves God, yet a politician can’t work in another party and still serve his or her people? I used to think our problem was leadership. Now I’m not so sure. What goes around will come around.
Allegations of mismanagement within the NDDC. Are you happy about the probe and what would you like to see going forward?
Oh yes. I am. For two reasons. The first is I know many heads will roll. Secondly, heads rolling signifies consequences. That is the singular most significant reason why we are where we are today. There are no consequences for our actions. Change that and you change everything. Why be good when being bad has no consequence?
You were into movie production. Why did you stop?
God forbid!! Me stop. Not possible. I am alreadyvworking on my next project. My scriptwriter and I are having lunch in London tomorrow just to review our progress. So the entertainment industry is not a passing phase for me. It’s what I hold dear. Two of my kids are coming for that lunch meeting. One is in Princeton and he wants to become a Producer. My daughter is already making waves in the UK film industry on major HBO productions and wants to be a writer/director. Her CV is intimidating. She just graduated with a first class. So film production is in the family. It’s just that I believe in taking my time. It shows in the productions.
Finally, give us your assessment of 2019 with regards to the Buhari administration and tell us what your predictions for 2020 will be.
Well he won the election, so the 2019 story itself was that positive assessment. Looking at 2020, I think he wants to leave a legacy. That is good and bad news. The good news is he will take Nigeria to the next level of prosperity. I expect more jobs, increased investment, improved infrastructure, greater transparency and better fiscal management. The bad news is he will take no prisoners along the way and he will take some very tough short term decisions that have a longer term positive impact. He isn’t contesting for an election and he has the future of the masses in his mind. My only advice will be for him to pay attention to healing the nation. Politicians play on our divisions to get power. Now that they have lost it, patriots should play on our unity to keep Nigeria strong.
APC NWC has set up a national reconciliation committee but some are already kicking against the composition. Will there be genuine reconciliation because there are certain people who believe nothing good can come out of Oshiomhole?
I don’t share that view. Anyone who wants to make progress should have no problem embracing peace. I’m an optimist with an umbrella like I said before. Let’s give peace a fair chance. The proof in the pudding is in the eating. Let them start work.
The emergence of Ovie Omo Agege as leader of the party in south south. Some people boycotted the meeting that produced him: Godswill Akpabio, Rotimi Amaechi, Godwin Obaseki. Can we say their absence showed a crack within?
You can say it but it won’t be true. I believe the Deputy Senate President is now the highest political officer from the South South, so he is not really contesting political leadership with anybody. The media often like to read meaning into innocent issues. Maybe because controversy sells. Amaechi, Akpabio, Sylva and even Oshiomole have large profiles and could easily provide leadership for the region, but the respect for the office of the DSP and their preference to focus on their jobs means, this isn’t a matter for debate.
Buhari has said he won’t contest in 2023. So many tendencies smarting for the ticket. Which of these will pick the ticket and do you forsee the cabal producing a candidate by proxy, despite Buhari warning that no one should drop his name?
I won’t be tempted to speculate. If as has been established , a week is a long time in politics, how much more time is 3 years? There are too many actions the President can take that will affect the outcome. The worst mistake anyone should make is to underestimate the role of the President. Even his silence will speak volumes.
DAPO ABIODUN AND TASCE IMBROGLIO
By: Ade Balogun
In the twilight of the Amosun-led administration in Ogun State, the media was awash with the heartrending stories of the sufferings of the staff of Tai Solarin College of Education, Ogun State.
We were made to understand, through incontestable facts and figures, that the Ogun State Government owed TASCE staff about 64 months’ salaries. This revelation, coupled with some other excesses of former Governor Amosun, was a major factor in the defeat of his anointed governorship candidate, Adekunle AbdulKadir Akinlade of the APM, at the polls.
Despite gross intimidation, people voted for the incumbent Governor, Prince Dapo Abiodun with the belief that he would undo all the evils of Amosun, especially with his electioneering promise of giving the much needed succour to the staff of TASCE.
Shortly after the inauguration of Governor Abiodun, I was amazed to find the staff of the College still protesting the non-payment of salaries! My amazement turned into pure horror when I later learnt that five of the staff at the forefront of the protests were arrested and incarcerated!
My bewilderment grew in leaps and bounds when the Governor, in a media chat, actually acknowledged that he ordered the arrest of the five staff of the College to instill discipline and respect for constituted authorities, like former Oyo state Governor, Isiaka Ajumobi did to the students and staff of Ladoke Akintola University if Technology (LAUTECH), in the staff of the college. I was greatly disturbed by the Governor’s statements and position on the TASCE issue.
While I will not support anarchy in a system, it is simple logic that a man or woman that is being owed 64 months salaries cannot be expected to be rational. The fact is that the government actually created the state of anarchy through the non-payment of their salary arrears.
In the same vein, the best way to instill respect for constituted authorities is not through draconian actions but through consultations. Respect is different from fear. A government that toes the Machiavellian usage of fear, instead of love, to put the citizenry in a state of bondage will reap a harvest of pure and undiluted hatred.
With the aforesaid, I was greatly elated when I stumbled on an article in the Nigerian Tribune of 23rd October, 2019 titled ‘Dapo Abiodun: Silent restorer of education lost glory in Ogun’. TASCE featured prominently in the said article and the writer made us understand that the Governor had done the needful to return normalcy and sustainable peace to the college.
Given the fact that the staff of the college had stopped their protests, I had no cause to disbelieve the information. I immediately called one of my friends in the College to rejoice with him but to my utmost dismay, I was informed that the Governor has not paid a dime out of the accrued salary arrears and that since his inauguration on May 29, 2019, he has only paid half salaries for the months of June and July, 2019 despite the fact that the 1st semester examination has been held and that the 2nd semester is also about ending.
It was also learnt the Provost of the college, in person of Dr. Lukman Adeola Kiadese had been earmarked 50 million naira for the upcoming convocation of the college, which to be held on December 18, but amount to wastefulness and misplacement of priority, why don’t him expended the aforesaid money to pay the part of the money owing his staff of the college? the Provost also need to be cautioned in the way and manner handling the crisis of the college if he want normalcy to return to the institution and the government should also implement the report of the visitation panel, headed by Prof. Kamaldeen Balogun, by paying the Lecturers six months recommended in the report and call them to a round table and discuss modalities on how to pay the outstanding salaries’ arrears of the staff.
There is also heavy police presence in the college and anyone who dares to protest the inhumane situation in the college is either molested or queried. Why all these? At least, we are no more in military junta which also communicate through armed policemen or soldiers. But, I went back to check the name of the author of the article and I immediately understood my folly in taking the information contained therein on face value. He is no other person than Olamide Lawal, the political jobber who was fingered in the arrest of the five TASCE Lecturers.
If indeed the power strategy is the government’s plan to ensure peace in TASCE, then God should have mercy on all of us in Ogun State.
Balogun, wrote in from Ijebu-Ode, Ogun State.
DEFORESTATION IN NIGERIA; THE CASE OF SHEA TREE PLANTATION AND IT’S ECONOMIC IMPLICATION
By: Anuoluwa Openiyi
It is no longer a strange phenomenon in Nigeria the extent to which deforestation is occurring in the wild. Deforestation is basically the cutting down of tress in the forest. It is a process where vegetation is cut down without any simultaneous replanting for economic or social reasons. These trees are known to be viable, useful, both for social, economic and developmental purpose. It is believed that Nigeria accounts for the world’s largest place where massive deforestation takes place.
Deforestation is not without any implication as it affects adversely on the social and economic structure of the country. Deforestation also has impacts on social aspects of the country, specifically regarding economic issues, agriculture, conflict, and amongst many other factors. According to data taken over 2000 to 2005, Nigeria, located in the western region of Africa, has the largest deforestation rates in the world, having lost 55.7% of their primary forests (Wikipedia online Resource, 2019). Whereas, primary forests can be seen as forests with no signs or trace of human activities. It can be rightly said that Nigeria has lost a huge part of her primary forest to deforestation due to human actions.
Deforestation in itself is something that is somewhat inevitable, but it will be rightly justified had it been there are adequate continuous re-planting of tree which are been cut down. As part of cases of cutting down of trees in Nigeria is that of ‘Shea Tree’. The Shea Tree is an economic viable tree which grows naturally on its own as it cannot be planted. It grows in specific places in some parts of Nigeria such as Niger, Oyo, and Kebbi States. In recent times, the Shea Tree faces severe victimization of deforestation as the tree is been cut on a large scale. The Shea Tree has economic importance. The fruits could be used for the production of Shea Butter, moisturizing-related products, and many other related items. It provides local employment and economic opportunities to women in rural areas, and also generates a distribution channel for one of its generating products; ‘’Shea Butter’.
Having involved myself to be among a group of social researchers who carried out an empirical study in Oyo and Niger States on the production of ‘Shea butter’ in 2018, certain discoveries were made. The process of this research allowed me to discover the danger the ‘Shea Tree’ is faced with as a result of deforestation. In the process of our findings, I did some photo-documentary of a number of ‘shea trees’ that were hewn already. Findings and field discoveries show that a large number of Shea Trees have been cut down on a large scale. Considering the fact the Shea Tree grows naturally on its own in specific places, the issue of re-planting is out the case. This poses serious challenge for local women who benefits economically from the Shea Tree.
There is a need for urgent step to be taken across board so as to prevent further cutting down of Shea Trees. It is time for policy makers, stakeholders, and academia to come up with policies which would be implemented for the safe-keep of this magnificent natural resource.
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